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In this episode of Cracking Addiction, Scot Aitken and Dr Ferghal Armstrong chat about Johan Hari’s book, Chasing The Scream. We explore some of themes of the book including the motivations that underpin the war on drugs, the economic factors that affect the war on drugs and the role of decriminalization of drug use. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we are again joined by Dr Colin Mendelsohn to discuss the controversies around vaping including the risks around vaping, the thoughts of vaping being a gateway to smoking cigarettes, the risks of EVALI, the role of 'Big Tobacco' in vaping, looking at the evidence around vaping and challenging some of the latest reviews around vaping Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In part 2 of 3 episodes. In this episode of Cracking Addiction we are again joined by Dr Colin Mendelsohn to discuss the different types of vaping products on the market, the different types of nicotine e-liquids available, how to source vaping products, how to prescribe nicotine and how to vape safely. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In this 1st of three episodes of Cracking Addiction we are joined by Dr Colin Mendelsohn to discuss the harms of tobacco usage, what vaping is and how vaping can be useful to aid smoking cessation, the myths and benefits surrounding nicotine and the efficacy of vaping in smoking cessation. Nicotine vaping is surrounded in mystery with a lot of myths and misinformation abounding and in this episode we try and dispel some of this misinformation. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss tobacco use in pregnancy and the those with mental health disorders and the evidence around smoking cessation in these special population groups. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss various smoking cessation interventions including behavioural interventions, nicotine replacement therapy, varenicline, bupropion and nortriptyline to aid patients in stopping smoking. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In this episode of Cracking Addiction we discuss the harms associated with tobacco use, the health benefits of tobacco cessation, briefly discuss smoking cessation interventions and highlight the importance of brief interventions in eliciting behaviour change. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In Episode 38 of Cracking Addiction we summarise the previous episodes regarding opioid use disorder and discuss a framework on the safe management of patients with opioid use disorder. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 37 of Cracking Addiction we discuss in detail some of the social comorbidities associated with substance use disorders and what to screen for, be aware of and some management strategies to tackle these social comorbidities. Social isolation and alienation are some of the unfortunate hallmarks of substance use disorder. Some of the biggest social harms that occur to the patient are the harms that can occur with increased rates of unemployment, homelessness, broken relationships and social isolation. Loneliness appears to be a significant product and by-product of substance use disorder and can lead to worsening outcomes. Some of the social harms to society include the role of acquisitive crime to fund drug usage in some circumstances, increased rates of violence and domestic violence in particular as well as potential risks of child endangerment and child welfare concerns. It is important that we focus on safety with the above concerns, and that in the case of domestic violence and child abuse that medical practitioners are aware of their mandatory reporting requirements and also how to support women and children in particular who are at risk of violence or other harms and which supports and services one can refer them to. The role of incarceration in the management of substance use disorder is controversial. History has provided numerous examples of where prohibition of drugs was ineffective and incarceration for substance use disorder (which is a medical condition) does not appear to be effective in reducing drug usage or it’s associated harms. Effective treatment of substance use disorder and consideration of decriminalisation of drugs and managing patients through diversion and rehabilitation programs would likely be of more benefit for the individual and society as a whole. Furthermore, by marginalising people with substance use disorder and treating people like criminals and incarcerating people we risk alienating and further stigmatising people. From a governmental perspective this could include less people participating in the workforce and a loss of tax revenue, the costs of incarcerating people and the costs of the criminal justice system to process people through this system. In summary there are significant social comorbidities associated with substance use disorder. Treating people with substance use disorders holistically, understanding the potential struggles which they might encounter and providing appropriate assistance might help decrease the social harms associated with substance use disorder for both the individual but society as a whole. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 36 of Cracking Addiction we discuss in detail some of the physical comorbidities associated with substance use disorders and what to screen for, be aware of and some management techniques. People with substance use disorders often deal with many medical and physical issues that can impact both their quality of life but also increase the risks of morbidity and mortality. There are a number of medical and physical conditions that could be discussed but for the sake brevity this blog post will detail the following: • Chronic pain • Tobacco use • Infectious diseases • Chronic NSAID toxicity Chronic pain Chronic pain alters brain’s stress and reward systems and increases the risk for developing an opioid use disorder. It is thought that up to 30% of chronic pain patients misuse prescription opioids and this is becoming an increasingly problematic matter within society. Recent data and statistics reveal that prescription drug deaths in Victoria now exceed the road toll. The treatment and management of chronic non-cancer related pain is now moving away from a medication centred approach and indeed chronic opioid medication usage are associated with long-term harms within this group including increased risks of opioid induced hyperalgaesia, osteoporosis and hypothalamic pituitary gonadal axis dysfunction. The management of chronic non-cancer related pain now increasingly centres around active pain management strategies, physical therapy, allied health input and rehabilitation activities. Tobacco use Many patients with substance use disorders smoke tobacco and broaching smoking and tobacco cessation is important to improving the overall health and wellbeing of the patient. Oftentimes it appears other drugs and substances take priority of tobacco usage but tobacco usage is also associated with significant harms to the patient. It is important to discuss the harms of smoking with patients with substance use disorders and offer smoking cessation interventions. Tobacco usage is responsible for the majority of lung cancer and approximately one-third of all cancer related deaths. Tobacco use is also directly responsible for: cardiovascular disease, reduced immunity, poor wound healing, age related macular degeneration and worsening chronic pain. Infectious diseases Patients with substance use disorder are at increased risk of some infectious diseases and it is important to screen people appropriately. In particular people who inject drugs and share needles or who engage in commercial sex work to pay for drugs require screening for blood borne viruses and the latter group in particular will require a thorough sexually transmitted infection screen. Blood borne virus screening includes screening for Hepatitis B, C and HIV and STI screening includes screening for chlamydia, gonorrhoea and syphilis in the first instance. People who inject drugs are also at risk of skin infections and abscesses as a result of injecting drug use and skin examination should be carried out periodically to exclude thrombophlebitis in veins, cellulitis and one should always consider the risks of infective endocarditis in the appropriate clinical scenario. It is important to be thorough and systematic in our physical examination of our patients and when ordering tests so as not to miss an important medical diagnosis. Chronic NSAID toxicity Codeine misuse and dependency associated with chronic non-steroidal anti-inflammatory drug (NSAID) toxicity. NSAIDS can ulceration of the gastrointestinal tract which can lead to bleeding and even perforation of the gastrointestinal tract in severe circumstances. Chronic NSAIDs usage can lead to iron deficiency with or without anaemia due to bleeding from the gastrointestinal tract. Chronic NSAID usage can also lead to recurrent metabolic acidosis and also cause significant renal impairment and lead to NSAID nephropathy which can be so severe as to need renal replacement therapy and can cause...

In episode 35 of Cracking Addiction we discuss in detail some of the psychiatric comorbidities associated with substance use disorders and what to screen for, be aware of and some management techniques. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 34 of Cracking Addiction we discuss how to manage some of the special circumstances in opioid substation therapy including OST in renal and hepatic impairment, managing polypharmacy complications with OST and managing acute pain whilst a patient is on OST. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 33 of Cracking Addiction we discuss how to manage some of the special circumstances in opioid substation therapy including vomiting of doses of OST, dealing with intoxicated patients, overdoses of OST and transitioning between Methadone and Suboxone and vice versa. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 32 of Cracking Addiction we discuss the harm reduction intervention of Naloxone and when to consider prescribing this medication, the benefits of take home naloxone and how it saves lives! Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 31 of Cracking Addiction we discuss the harm reduction interventions that we can implement for people who inject drugs to decrease the risks of morbidity and mortality. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 30 of Cracking Addiction we discuss the different opioid receptors buprenorphine acts upon and the nature of these effects, the difference between agonists and antagonists, how to start a patient on Suboxone and how to monitor patients on Suboxone and adjust doses. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 29 of Cracking Addiction we discuss Suboxone and talk about the components of Suboxone as well as the pharmacology and pharmacokinetics of Suboxone. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

In episode 28 of Cracking Addiction we discuss our practical tips, advice and experience in managing patients on LAIB and share what we have learned. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

Episode 27 of Cracking Addiction discusses the patient journey on LAIB and how to adequately deal with and manage adjusting doses of LAIB, commencing and ceasing LAIB and ensuring that patients are maintained on LAIB therapy Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au

Cracking Addiction discusses Sublocade one of the LAIB preparations available and how to commence, maintain and manage any dose changes or complications associated with Sublocade. Sublocade is a long acting injectable buprenorphine (LAIB) manufactured by Invidior that uses the “Atrigel” system to provide for a sustained and prolonged delivery of buprenorphine into the systemic circulation after subcutaneous injection. Latest Blogs https://www.meducate.com.au/blog About Meducate ® Meducate provides online education for doctors, clinicians, health professionals and the public. See the website to browse the many different talks and courses available https://www.meducate.com.au